Sarcopenia and Osteoporosis: Two Factors Affecting Hip Fracture Mortality in the Elderly

Öz

OBJECTIVE: Sarcopenia and osteoporosis the leading causes of hip fractures in elderly patients. This study aimed to evaluate the effects of sarcopenia related to psoas muscle index and osteoporosis obtained by T score on mortality in hip fracture patients. MATERIALS AND METHODS: This retrospective cross-sectional study examined 236 patients after a hip fracture. The patients were sarcopenic and nonsarcopenic according to the psoas muscular index; According to the femoral neck T score in Dual Energy X-ray Absorptiometry, patients were grouped as low (<-2.5) and high (≥-2.5) and compared. Statistically significant variables associated with 30 days and one-year mortality were analyzed using logistic regression analysis. RESULTS: Eighty-four (35.6%) patients were in the sarcopenia group, and 152 (64.4%) were in the non-sarcopenia group. Ninety-two (38.9%) patients were in the low group, and 152 (61.1%) were in the high group. In the sarcopenia and the low T score groups, the frequency of females, ≥65 years, comorbid disease, intensive care unit requirement, and complications rates were significantly higher. The survival rate was significantly lower (p<0.05). Female gender [odss ratio (OR): 2.97, 95% confidence interval (CI): 1.17-7.54], sarcopenia (OR: 3.65, 95% CI: 1.68-7.91), low T score (OR: 2.62, 95% CI: 1.23-5.62), intensive care unit requirement (OR: 2.32, 95% CI: 1.09-4.92) and presence of postoperative complications (OR: 2.89, 95% CI: 1.32-6.36) are significant risk factors for 1-month mortality; female gender (OR: 2.04, 95% CI: 1.06-3.94) and presence of sarcopenia (OR: 2.24, 95% CI: 1.22-4.09) are risk factors for 1-year mortality (p<0.05). CONCLUSION: Detection of sarcopenia and osteoporosis in elderly patients at the early stage and correction of modifiable factors are of great importance in improving postoperative outcomes and reducing mortality.

Anahtar Kelimeler

• Hip fractures
• sarcopenia
• osteoporosis
• postoperative outcomes
• mortality

Sarkopeni ve Osteoporoz: Yaşlılarda Kalça Kırığı Mortalitesini Etkileyen İki Faktör

Öz

AMAÇ: Sarkopeni ve osteoporoz yaşlı hastalarda kalça kırıklarının önde gelen nedenleri arasındadır. Bu çalışmada kalça kırığı hastalarında, psoas kas indeksine bağlı sarkopeni ve T skoru ile elde edilen osteoporozun mortalite üzerine etkisinin değerlendirilmesi amaçlandı. GEREÇ ve YÖNTEM: Bu retrospektif kesitsel çalışmada kalça kırığı sonrası 236 hasta incelendi. Hastalar psoas kas indeksine göre sarkopenik olan ve sarkopenik olmayan şeklinde; Dual-Energy X-ray Absorptiometry femur boynu T skoruna göre düşük (<-2,5) veya yüksek (≥-2,5) T skoru olarak gruplandırıldı ve karşılaştırıldı. Otuz günlük ve bir yıllık mortalite ile ilişkili istatistiksel olarak anlamlı değişkenler belirlendi ve lojistik regresyon analizi kullanılarak analiz edildi. BULGULAR: Sarkopeni grubunda 84 (%35,6), sarkopeni olmayan grupta 152 (%64,4) hasta vardı. T skoru düşük grupta 92 (%38,9), yüksek grupta 152 (%61,1) hasta mevcuttu. Sarkopeni ve düşük T skor gruplarında ≥65 yaş, kadın cinsiyet, ek hastalık varlığı, cerrahi sonrası yoğun bakım ünitesi takibi ihtiyacı ve cerrahi sonrası cerrahi komplikasyon oranları anlamlı olarak daha yüksekti. Hem sarkopeni hem de T skoru düşük grupta sağkalım oranı anlamlı olarak daha düşüktü (p<0,05). Kadın cinsiyet [olasılık oranı (OO): 2,97, %95 güven aralığı (GA): 1,17-7,54), sarkopeni (OO: 3,65, %95 GA: 1,68-7,91], düşük T skoru (OR: 2,62, %95 GA: 1,23-5,62) ve cerrahi sonrası komplikasyon varlığı (OO: 2,89, %95 GA: 1,32-6,36) 30 günlük mortalite için bağımsız risk faktörleriyken; 1 yıllık mortalitede sadece kadın cinsiyet (OO: 2,04, %95 GA: 1,06-3,94) ve sarkopeni varlığı (OO: 2,24, %95 GA: 1,22-4,09) bağımsız risk faktörleri (p<0,05) olarak gözlendi. SONUÇ: İleri yaş hastalarda sarkopeni ve osteoporozun en erken dönemde saptanması ve değiştirilebilir faktörlerin düzeltilmesinin cerrahi sonrası sonuçların iyileştirilmesi ve mortalitenin azaltılmasında büyük önem taşmaktadır.

Anahtar Kelimeler

• Kalça kırığı
• sarkopeni
• osteoporoz
• psoas kas indeks
• mortalite

Kaynakça

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